Inhalation with fucose and galactose for treatment of Pseudomonas aeruginosa in cystic fibrosis patients

Abstract

Background: Colonisation of cystic fibrosis (CF) lungs with Pseudomonas aeruginosa is facilitated by two lectins, which bind to the sugar coat of the surface lining epithelia and stop the cilia beating.

Objectives: We hypothesized that P. aeruginosa lung infection should be cleared by inhalation of fucose and galactose, which compete for the sugar binding site of the two lectins and thus inhibit the binding of P. aeruginosa.

Methods: 11 adult CF patients with chronic infection with P. aeruginosa were treated twice daily with inhalation of a fucose/galactose solution for 21 days (4 patients only received inhalation, 7 patients received inhalation and intravenous antibiotics). Microbial counts of P. aeruginosa, lung function measurements, and inflammatory markers were determined before and after treatment.

Results: The sugar inhalation was well tolerated and no adverse side effects were observed. Inhalation alone as well as combined therapy (inhalation and antibiotics) significantly decreased P. aeruginosa in sputum (P < 0.05). Both therapies also significantly reduced TNFalpha expression in sputum and peripheral blood cells (P < 0.05). No change in lung function measurements was observed.

Conclusions: Inhalation of simple sugars is a safe and effective measure to reduce the P. aeruginosa counts in CF patients. This may provide an alternative therapeutical approach to treat infection with P. aeruginosa.

Keywords: Cystic fibrosis; Pseudomonas aeruginosa; fucose; glactose; inhalation; lectin.

Figure 1

Sputum counts of P. aeruginosa before (pre) and after (post) treatment with inhalation alone (p. i.) or combined treatment with inhalation and i. v. antibiotics (p. i. + i. v.). Mean+SEM. *: P < 0.05 vs pre.

Figure 2

TNFα mRNA expression in sputum cells (A) and in PBMC (B) before (pre) and after (post) treatment with inhalation alone (p. i.) or combination of inhalation with antibiotics (p. i. + i. v.). Mean+SEM. *: P < 0.05 vs pre.

Figure 2

TNFα mRNA expression in sputum cells (A) and in PBMC (B) before (pre) and after (post) treatment with inhalation alone (p. i.) or combination of inhalation with antibiotics (p. i. + i. v.). Mean+SEM. *: P < 0.05 vs pre.

Figure 3

TNFα serum protein levels before (pre) and after (post) treatment with inhalation alone (p. i.) or combined treatment with inhalation and i. v. antibiotics (p. i. + i. v.). Mean+SEM. *: P < 0.05 vs pre.